A statement of explicit consent, limited to a specific purpose, regarding the medical history you shared in your online preliminary consultation request.
After being informed by the data controller Assoc. Prof. Dr. Barış Çakır via the KVKK Information Notice, I hereby give my explicit consent for the information I voluntarily shared in the online preliminary consultation form—including my history of nose fillers and nose surgery, the approximate dates of these procedures, and any additional health-related details—to be processed I hereby give my explicit consent for the processing of this information for the purpose of evaluating my preliminary consultation request and contacting me regarding this request.
In this context, my health information, along with my first and last name, age, gender (if applicable), and contact information, is recorded in the application. It is submitted to the authorized physician and the communications team for the request; it is processed by the technical service providers necessary for storing the form and sending the email notification, limited to the relevant purpose.
This statement does not imply that I consent to the sending of advertising or promotional messages, the publication of my photos and videos, the sharing of my information with unspecified third parties, or any transfers of data abroad. It does not serve as a substitute for informed consent for medical examination and treatment.
I may choose not to share my medical history through this online form. In that case, I may request an initial consultation via the phone or email channels on the contact page without providing my medical history. This choice cannot be used as a general prerequisite for receiving healthcare services.
I may withdraw the consent I have provided through the channels described on the KVKK Application page. Withdrawal does not retroactively invalidate past processing activities based on that consent. Future processing activities and requests for data retention will be evaluated in light of other applicable legal obligations and rights.
Viewing this page does not in and of itself constitute a declaration of informed consent. The separate, unchecked informed consent field on the preliminary interview form is checked by the individual of their own volition prior to submission. The acknowledgment that the individual has read the information notice is distinct from the declaration of informed consent.
Short statement to be used in the form: “Within the scope outlined in the Preliminary Consultation Informed Consent Form, I hereby give my informed consent for the health information I voluntarily share in this form to be processed for the purpose of evaluating my request for a preliminary consultation and contacting me.”